Many practices are moving away from the traditional model and exploring opportunities to work collaboratively with neighbouring practices, or considering a more formal approach and merging – with the overall aim being sustainability! In fact, it was stated in the GPFV that “It is becoming increasingly normal for general practices to work together at scale, and already over half the country have formed into networks or federations of practices”.

Has this signalled the end of individual practices? Is it due to the advances in technology, the pressures placed on general practice or a combination of factors? The latter is likely and as a result, practices must identify new ways of working if they’re to survive. Could a merger be the answer? Why merge? Well, surely the answer must be that you want to create a service that meets the needs of the entitled patient population. As well as reducing costs by pooling resources, sharing responsibilities, moving into a single building, etc.

You may be of the same opinion as Richard Branson: “Business opportunities are like buses: there’s always another one coming.” But can the same be said about merging opportunities in general practice? Probably not. So you really do have to consider your options to ensure your practice has long-term sustainability in the ever-changing general practice environment. Just remember, there’s no one-size-fits-all approach, so maybe merging isn’t for your practice and you may opt for a more informal collaboration.

Let’s take a look at the benefits of merging. I’ll begin with the subject of finance. Maintaining decent profits can be challenging, so maybe the ability to share facilities/premises is one way in which merging can help to maintain a healthy profit margin. Another element of finance is the opportunity to buy in bulk and reduce costs in that way. Or perhaps merging will increase opportunities when bidding for contracts as you’ll be a larger entity.

Patient choice is another key benefit. By merging, practices can increase the volume and type of services offered to their patients. This can include increased/extended patient access as you’ll have greater capacity and much more flexibility than smaller practices. This links nicely with the next element, resources.

The merging of two (or more) practices will enable economies of scale; the workload can be shared and the pressures reduced. There may be a chance to further develop the workforce, introducing cross-functional team-working and improved personal development, which in turn will support and lead to improved patient outcomes. Also, there can be a financial benefit here too. If one practice was heavily reliant on locums and the other wasn’t, the workload could be shared, which would undoubtedly reduce the locum requirement. This can apply to administrative roles too, if there had been a need to use agency workers in the past.

So that’s just a few of the benefits. But it’s only right that the disadvantages are examined too. We all know that planning is key in any sector, and healthcare is no exception. If the merger isn’t planned effectively, it could lead to poor working relationships and potentially, and significantly, the failing of the merger. That’s why it’s essential that mergers are planned in detail.

Patient access could be affected both positively and negatively. If your practice has moved into a single site, this may make it harder for some patients to gain access due to location, travelling time, etc. So whilst the services offered may have improved, some patients may find it harder to attend their appointments.

Independence is an area that can cause difficulty as partners, after the merger, may have less influence in the decision-making process, as there are likely to be more of them. To mitigate this, practices can determine the roles of each partner during the planning phase, outlining key responsibilities and the decision-making process, ensuring partners understand they’re all equal and their voice will be heard.

If one practice has more liabilities than another, this can also prove to be an issue, unless mitigating action is taken to protect the practice which does not have these liabilities. This is where specialist input and advice are essential; you don’t want to leave your practice exposed to any liabilities inadvertently!

Whilst there may be other disadvantages, the following quote acts as a good summary: “You should never view your challenges as a disadvantage. Instead, it’s important for you to understand that your experience facing and overcoming adversity is actually one of your biggest advantages” – Michelle Obama.

So if you’re at the stage where you think merging is the right option for your practice, due diligence must be undertaken. After which, and if both practices are in agreement about the merger, the next step is registration with NHSE and the CCG. More detailed guidance about mergers can be found in the guidance document [PLUS]. Merging may prove to be the key to sustainability for your practice; can you afford not to give it serious consideration?

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